RU2205603C1 - Method for operative treatment of pseudoarthrosis and nonhealing fractures of long tubular bones - Google Patents

Abstract

FIELD: veterinary science, veterinary surgery. SUBSTANCE: the suggested method deals with reconstructive-restorative operation and includes portion resection of osseous fragments' ends, carrying out their osseous-periosteal decortication along with bilateral tunnelization, and autotransplantation of bony tissue into area of previous pseudoarthrosis followed by carrying out extramedullar osteosynthesis and cerclage fixation of autotransplant. The method enables to achieve complete consolidation of osseous fragments and restore functional usefulness of traumatized limb. EFFECT: higher efficiency of therapy.

Description

 One of the most pressing problems in humanitarian and veterinary traumatology is the restoration of the integrity of long tubular bones with pseudoarthrosis, non-healing fractures and bone defects. In surgical and conservative treatment of tubular bone fractures, pseudoarthrosis and non-healing fractures, as complications, range from 7.8-33.1% [1; 2; 3; 4]. Clinical, X-ray, and morphological correlations in pseudoarthrosis and non-healing fractures indicate the absence of consolidation of bone fragments. The pathological painless mobility of fragments at the fracture level is palpated, clinically - the complete functional unsuitability of the injured limb.

 In veterinary traumatology, there are no fundamental works on the study and treatment of pseudoarthrosis and non-healing fractures of long tubular bones in dogs.

 The closest analogue of the invention is a method of surgical treatment of a pseudoarthrosis in humans by osteosynthesis with a metal plate [5]. A method of treating a pseudoarthrosis in humans is as follows: expose the pseudoarthrosis zone, secrete bone fragments, opening the medullary canal. Bone fragments map end to end and are held by a bone holder. A metal plate is placed on the outer surface of the bone under the periosteum, drilled one hole in the proximal and distal fragments, and the plate is fixed through them with two screws. At the junction of the fragments, a graft taken from the iliac wing is wall-walled, and it is fixed with 1-2 metal screws. The wound is sutured.

It should be noted that the described method has a number of significant disadvantages:
1. Bone fragments map end to end without resecting the sclerotic ends of the fragments. There is reason to argue that the sclerosed ends of the fragments are not capable of adequate regeneration [6; 7].

 2. The plate is fixed to bone fragments with only two screws (one screw on each side of the fracture line), which, according to the laws of biomechanics, cannot provide a fixed backlog of the plate - screw - bone under the conditions of uncontrolled movements of the animal.

 3. The plate is placed under the periosteum, exfoliating the latter from the bone fragments, which, in turn, may adversely affect the processes of osteoreparation.

 4. Parietal implantation may not have the full ability to osteoreparative, since it stimulates only periosteal layers.

 In the postoperative period, as a result of insufficiently strong fixation of fragments, a number of complications are noted: displacement of bone fragments along the length and width, fracture of the autograft, rejection of the autograft and metal retainer.

 The present invention is to eliminate the above disadvantages, by a new method of reconstructive surgery, which avoids the described complications, as well as completely restore the length of the damaged bone and the functional fitness of the injured limb.

 The method includes the extraction of bone fragments into the surgical wound, opening the bone marrow canal, osteosynthesis with a plate and autotransplantation of bone tissue, characterized in that after the extraction of bone fragments into the surgical wound, an additional portion resection of the ends of the fragments is carried out, they are tunneled, bone periosteal decortication and extramedullary osteoarthritis are performed by applying a Kashin-Antonov plate to bone fragments, preserving the original bone length and not covering the periosteum plate th, after which the plate is fixed to bone fragments with screws passing in two mutually perpendicular directions, and the diastasis formed between the bone fragments is filled with an autograft, introducing it into the bone marrow canal and additionally fixing it to the plate with a seam seam using a wire. The method of surgical treatment of pseudoarthrosis and non-healing fractures of long tubular bones in dogs is as follows. After conducting operative access to the pseudoarthrosis region, a portion resection of the ends of the fragments is carried out until they begin to bleed.

 Then, using a sharp bit and a thin drill, bone-periosteal decortication and extensive tunneling of the ends of the fragments are performed, loosening the periosteum around the circumference of the proximal and distal fragments and drilling canal tunnels in different directions in the area of the former pseudarthrosis. After this, extramedullary osteosynthesis is performed with a Kaplan-Antonov plate, maintaining the intact bone length and fixing a metal retainer to it with six screws (three screws on each side of the osteotomy line). It should be noted that in this case, the screws should be inserted in two mutually perpendicular directions, thereby creating a geometrically motionless plate-screw-bone backlog, which excludes any mobility at the fracture level.

 The next stage of reconstructive surgery is the autotransplantation of bone tissue from the iliac wing into diastasis between the bone fragments. To do this, the autobone is tightly hammered intramedullary into the pre-drilled bone marrow canal of the proximal and distal fragments. In addition, the autograft is split into longitudinal “strips” and encircled with the region of the former pseudoarthrosis as a “bundle of brushwood”, fixing them with a wire chain. The surgical wound is sutured in layers tightly.

 X-ray it was established that mineralization begins in the periosteal regions of the regenerate near bone fragments and spreads to other parts of it. A number of factors can influence the course of this process: temperature, pH of the medium, concentration of pyrophosphates, level of prostaglandins, proteoglycans, etc.

 It is morphologically shown that the front of replacement of the cartilaginous bone tissue goes from the periosteal zones to the interfragmental one. This leads to the formation of a secondary regenerate, consisting of spongy bone tissue in all its zones: periosteal, endosteal and interfragmental. Researchers associate the preservation of small islets of cartilage in the regenerate with the local absence of vessels here. This stage of regeneration proceeds to the next, which is expressed in the restructuring of the spongy regenerate, accompanied by the transformation of its tissues into compact osteon structures and the subsequent resorption of all bone structures that are not in the areas of the main load, the permanent stage of bone reconstruction is resumed under conditions of motor activity.

 The final restructuring of osteon structures at the site of the inter-fragment zone continues for a long time. The formation of a regenerate, even with a normal process, can last from several weeks to several months. Often, despite the fact that the fracture is osteoreparated clinically and functionally, it is still determined radiographically. However, the high plastic properties of bone tissue initiate the complete consolidation of fragments in the region of pseudoarthrosis, which finds clinical and radiological confirmation.

 Thus, a portion resection of the ends of the fragments, their bone-periosteal decortication with extensive tunneling, as well as subsequent extramedullary osteosynthesis with autotransplantation of bone tissue intra- and extramedullary to the diastasis region by the type of “brushwood brushing” and its fixation by wire church surgery should be considered as and a method for surgical treatment of pseudoarthrosis and non-healing bone fractures in dogs.

Sources of information
1. Bogdanov F.R., Antonyuk I.G. About surgical treatment of patients with complicated pseudoarthrosis and tibia defects. -Orthopedics, traumatology and prosthetics., 1965, 3, pp. 9-14.

 2. Tkachenko S.S., Rutsky V.V. Electrical stimulation of osteoreparation in the treatment of delayed fusion and false joints of bones. - Orthopedics, traumatology and prosthetics., 1982, 1, p. 4-8.

 3. DeAngelis M. P. Causes of delayed union and nonunion of fractures. Management of limb fractures in small animals // Vet. Clin. North am. 1975. May. P.129-131.

 4. Hurov L. I. Plating and grafting for nonunion of a subtrochanteric femoral fracture in a dog // Can. Vet. J. 1984. V. 25, 5. P. 211-213.

 5. Shumada I.V., Rybachuk OI, Zhila Yu.S. Treatment of false joints and defects of the diaphysis of the tubular bones. - Kiev: Health'ya, 1985.-152 p.

 6. Korhov V.V. Surgical treatment of false joints. - L .: Medicine, 1966.-231 p.

 7. Chaklin V.D. Bone grafting. -M .: Medicine, 1971.-227 p.

Claims (1)

 A method for the surgical treatment of pseudoarthrosis and non-fused fractures of long tubular bones, including the extraction of bone fragments into the surgical wound, opening of the bone marrow canal, osteosynthesis with a plate and autologous bone tissue transplantation, characterized in that after the extraction of bone fragments into the surgical wound, an additional portion resection of the ends fragments, they are tunneling, bone-periosteal decortication and extramedullary osteosynthesis, imposing a Kaplan-Antono plate and on the bone fragments, preserving the original length of the bone and not covering the plate with the periosteum, after which the plate is fixed to the bone fragments with screws passing in two mutually perpendicular directions, and the diastase formed between the bone fragments is filled with an autograft, introducing it into the bone marrow channel and additionally fixing to the plate with a seam using a wire.